Provider Demographics
NPI:1700850401
Name:MILLER PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MILLER PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILVAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:318-487-0211
Mailing Address - Street 1:3912 PARLIAMENT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3015
Mailing Address - Country:US
Mailing Address - Phone:318-487-0211
Mailing Address - Fax:318-445-6697
Practice Address - Street 1:3912 PARLIAMENT DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3015
Practice Address - Country:US
Practice Address - Phone:318-487-0211
Practice Address - Fax:318-445-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA368814261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC3524OtherBC/BS-LA CLINIC PROV #
LAC3524OtherBC/BS-LA CLINIC PROV #